Oregonians between the ages of 5 and 11 may be able to get vaccinated as soon as next week. Yesterday, the CDC recommended children in that age group should receive the Pfizer-BioNTech pediatric vaccine against COVID-19. Oregonians under the age of 12 will be able to get vaccinated soon. Oregon Health Authority director Patrick Allen joins us to talk about where and when young Oregonians will be able to get vaccinated. We also hear from pediatrician Ryan Hassan about the concerns parents and kids might have about vaccines.

This transcript was created by a computer and edited by a volunteer.

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Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Yesterday, the U.S. Center for Disease Control and Prevention approved The Pfizer-BioNTech COVID-19 vaccine for kids, ages 5-11. It was the federal government’s final seal of approval. In Oregon, there was one more step. It came this morning after the western states scientific safety review workgroup met. That group is made up of officials from Washington, Oregon, California and Nevada. They checked the feds work and found it good. This means that more than 300,000 Oregon kids can now get the best protection we have against the once novel coronavirus. For more on this news, I’m joined by Patrick Allen, the head of the Oregon Health Authority and Ryan Hassan, a pediatrician from Happy Valley. He is also on the medical advisory board of Boost Oregon, which provides evidence-based information about vaccines. Welcome to you both.

Patrick Allen / Ryan Hassan: Thanks for having me. Thank you.

Miller: Ryan Hassan, first. How significant is this news?

Hassan: For people who have kids aged 5-11, it’s pretty significant. Most of the patients that I’ve been working with have been very eagerly anticipating this day, including one of my colleagues who works in my office with me who has kids in that age range. I’m sure she’s looking right now to sign her kids up for the earliest time to get vaccinated. So, it’s just a huge burden of relief for many of these parents.

Miller: It seems like maybe we’re talking about two different groups. When you said that a lot of your patients have been eagerly anticipating this, and you’re also talking about their parents, do you hear, say, from seven year olds that you see that they really want this shot?

Hassan: Yeah. Actually, surprisingly so. I mean, it’s not as common, I’d say. I think more so the parents are excited. But I do have many patients, the children themselves, who are actually telling me ‘I can’t wait to get this shot so I can not worry about getting sick anymore’. Of course, there’s still many more who are just like, ‘I don’t like shots. I don’t want a shot’. But their parents are doing, I think generally, a good job of reminding them, ‘hey, you know what, it’s better than the alternative. Then you don’t have to wear your mask as much and you can not worry about COVID as much’.

Miller: How much do you think about this as a medical provider? Obviously, you’re in a safe place, everyone’s wearing masks in your office. But you’re also being exposed on a regular basis to a bunch of unvaccinated people just by virtue of their age?

Hassan: I appreciate that question. It doesn’t bother me as much now, because I think I’ve kind of grown accustomed, for one thing. It’s just a nature of being human as you become more familiar with a thing, it becomes less scary. Which is part of the reason the pandemic has continued, is because people aren’t as scared of it because we know more about it even though it’s still just as dangerous. So to some extent that’s true for me too. I do it all the time. So I don’t worry about it as much because, if I worried about it as much as I were a few months ago, I just wouldn’t be able to function. But there is some degree of worry that I bring home every day when I come and see my baby and wonder is it possible I could get her sick?

But also, I now have the assurance of knowing the data that I have had my three doses of vaccine and that I am extremely well protected and that my baby, she’s seven months old, she has very, very low risk of severe complications. And of course we have the masks. I have an N-95 I wear. So, I have a lot of layers of protection. I know that that keeps me safe. For the most part I’m not as worried, but it is something that is still in the back of my mind anytime I enter a room.

Miller: Patrick Allen, what’s the timeline right now in terms of widespread availability for this age group?

Patrick Allen: The biggest limitation to availability right now for this age group is going to be the actual supply of vaccine. The federal government set out a shipping schedule. There is some vaccine in Oregon right now, and everything is in place for those who have that vaccine to begin administering it right away. But it’s only about 18,000 doses. There are about 330,000 kids who are now eligible. Demand is a little bit of a guessing game, but surveys seem to indicate somewhere between a quarter and a third of parents want to get their kids vaccinated right away. So that’s about 110,000 kids, potentially. So the 18,000 doses that are available right now is a little bit short. We’re gonna get about 55 [or] 56,000 more doses the rest of this week and then about 73,000 doses next week. I think one of the things we’ve learned, Dave, is that the first day that a big number of people are eligible to be vaccinated is a little bit like ‘Black Friday.’ If everybody tries to get through the door at the same time, it won’t work. But we’ll have plenty of vaccine in just the next short days to be able to meet that demand.

Miller: Right. To carry that shopping metaphor through, the sense that I get is it’s almost as if there’s Black Friday for a couple days in terms of a huge desire for a limited supply of something. And then the shopping metaphor would break down. If what we see going forward is anything like what we’ve seen in the past, it would almost be like stores just giving things away. That’s such a crazy flip from this huge demand, not enough supply, to a lot of supply and not that much demand. Is it fair to say that that’s what you’re expecting for this age group as well?

Allen: Well, a little bit. I think the uptake rate in older kids who are eligible has been pretty good and continues to grow at a pretty good clip. Right now, the supply is pretty closely balanced to what we think the demand is going to be. I think getting through that first quarter to a third who really want the vaccine right away will be pretty brisk business for two, three, maybe four, weeks. Then we’ll start eating into that second third that want to wait and see, and see how long they want to wait and see. See how education programs work and things like that. Dr. Hasan’s group, those kinds of things. I think we’ll see the demand continue to be pretty okay. But you’re right, it’ll definitely trail off after we get through that first body of people.

Miller: Where will parents and kids be able to get these doses?

Allen: All kinds of places. They’ll be able to get them at their participating pediatrician or family practice offices. They’ll be able to get them in pharmacies all across the state. We’ll have doses at federally qualified health clinics. Also, local public health will be running vaccination clinics in a number of locations that are drive-thru sorts of opportunities. Our own OHA field operations will be setting up opportunities for people to get vaccinated. So, it should be widely available at the place that your kids get their shots.

Miller: What have you learned about best practices for vaccine distribution for younger Oregonians, especially from the last time we had the one age group up get availability when 12-15 year olds were approved back in May? What lessons did the state take away from that?

Allen: Well, I think having vaccine widely available in lots of geographic locations and lots of places where people are used to going to get their health care is really valuable. I think the biggest difference with this age group is, there’s a big difference between vaccinating a five year old and vaccinating a 12 year old. So, we’ve got some locations where they may be reluctant to vaccinate down to that kind of age. I’m thinking potentially pharmacies or those kinds of things. I think we’re going to have to very carefully watch where vaccine is actually being used, make sure we get lots of it to those locations, and then provide assistance to make sure that we’ve got lots of opportunities, especially for the very youngest kids, to be able to get quickly and effectively vaccinated.

Miller: Dr. Hassan, maybe you can give us just a short layperson’s Immunology lesson for a second here. Can you remind us why it is that young kids need such a smaller dose than adults to get the same level of protection?

Dr. Hassan: Sure. I don’t know that I’d be the best person to provide the most detailed answer to that. But I could say that, in general, kids have more robust immune responses and don’t need as much of an antigen exposure to create immune responses, which is part of why we are able to vaccinate kids so young with very small doses of antigen and part of why, in general, the amount of antigen in vaccines has gone down in the last several decades as we’ve been able to improve our knowledge of vaccines and the vaccine manufacturing process.

Miller: I want to turn to the approval process itself at the federal level, because one of the most obvious things we’ve learned over the last 20 months is that, population-wide, COVID-19 is way more dangerous and much more deadly to someone who is 88 years old than someone who is eight years old. One of the big things that public health authorities were considering before authorizing the vaccine for this younger cohort was the relative benefits and risks of getting the vaccine versus not getting the vaccine. How did they reckon with this important data point that, even though many young people have been sickened and some have died, the numbers are way less stark than for much older people?

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Hassan: That’s a good question. There’s a few things to consider. There’s different reasons we’re vaccinating these younger age groups than safer older kiddos or adults, or even our seniors. Kids still directly benefit from the vaccine. That’s undoubtedly true. But there’s also the larger benefit to the rest of the community for vaccinating kids. So, in terms of the individual benefit, the FDA compared the expected side effects with the expected reduction in hospitalizations and deaths that would be prevented by a COVID vaccine, and they found that  we don’t know what the risk of myocardial is for kids at this age group, because we have the trial that took 3,100 kids or so. So the risk of myocarditis is for older kids, five in a million or so. So it’s very rare. It’s not something we’re gonna be able to find out until we start vaccinating lots of kids. So they assumed for this that the risk was the same as it is for older kids for the 5 to 11 age group, and with that assumption they found that you would have fewer cases of myocarditis, which is probably the most concerning side effects from the vaccine, than you would have hospitalizations prevented from the vaccine, except in the case where if we had really low transmission rates, like we did in June, but of course we don’t have those rates. So, that was the analysis they did to determine, ‘Okay, would you have more hospitalizations from COVID without the vaccine or you have more myocarditis cases from the vaccine?’

The important thing to remember there is that, even if you were to have more myocarditis cases, which they determined you very likely wouldn’t, myocarditis from the vaccine is pretty mild and generally very quick to go away and resolve. Hospitalization from the vaccine or from the virus is much more significant burden on people’s health and people’s quality of life. And of course there’s many other risks of infection. Even if you have a mild infection for kids that entails quarantining, isolating people around them, testing exposed contacts. Or even if you don’t get sick, if you’re unvaccinated, you have an exposure at your school, you have to be isolated at home for several days. So, there’s a lot of benefits for kids getting the vaccine, even though the benefit of reducing the risk for hospitalization is relatively small.

Miller: You mentioned school, what could the vaccination, in significant numbers, significant percentages of school age kids for this younger group, what could it mean in terms of quarantines and other disruptions to school that have been the hallmark of in-person instruction for months now?

Hassan: Every kid that gets vaccinated is one kid who no longer has to do any isolation if they’ve been exposed to COVID. If you’ve been exposed, as long as you’re not having symptoms, you don’t have to do any different precautions. You can continue going to school. So, if most of our kids are vaccinated, then even when there’s exposures, they can still go to school without getting those disruptions in their learning.

Miller: Can I interrupt? Patrick Allen, is that the way the Oregon Health Authority is going to give advice to the Oregon Department of Education and to schools about the way exposure would work, because I didn’t think that that’s the way it is currently for vaccinated, say 16 year olds?

Allen: No, Dr. Hassan is exactly right. If someone is vaccinated, then they are not required, if they don’t have symptoms, to quarantine in the case of an exposure.

Miller: Okay, so thanks for that clarification. That will then carry down through these younger groups? Meaning even if there are cases here and there, you don’t have to quarantine if you’re a kindergartner say, if you’re vaccinated?

Allen: Without symptoms, that’s correct.

Miller: I want to turn to Ryan Hassan. The kinds of conversations that you’ve been having, or you expect to have with parents, I’m curious if you’ve encountered parents who are not against a COVID-19 vaccine, maybe who eagerly got vaccinated themselves, but who told you that they’re not sure they want to have their little kids vaccinated right now. Have you encountered that?

Hassan: Oh, definitely. Yeah. I think I have a lot of families where they got their own vaccine,[but] they’re not so sure about the younger kids. Even for the older teenagers who have already been eligible, they waited or maybe are still waiting.

Miller: So what are they waiting for?

Hassan: It’s a good question. That’s what I try to explore with them. I don’t try to push parents who aren’t wanting to have a conversation, because I don’t find that’s helpful. But for those who do, I think the general sense is that they want to get more information and see how people handle the vaccine after we’ve vaccinated many kids and as more time has elapsed. What I try to explain is that we have enough data from the time that the phase three trials have progressed to allow for an EUA [Emergency Use Authorization] from the FDA. That decision is made once they deem that there’s enough data to know that, for any individual getting the vaccine, the risks outweigh the benefits. More data helps you understand more clearly what the small risks are, but we still know enough to say that it’s much more safe to get the vaccine in this young age group than not to. Even if we don’t know exactly, for example, what the exact risk of myocarditis after the vaccine is, because we know it’s small enough, it’s not going to outweigh the benefits.

Miller: It seems like you’re doing such a delicate maneuver here, because your ultimate goal is to increase vaccination rates. But as you’re saying, and as you’re describing it, you’ve found that having a heavy hand or being seen as pushing is not going to accomplish that goal. How successful is this lighter touch?

Hassan: That’s a good question. I’d say it’s the most successful approach that we have. It’s based on motivational interviewing, which is a method that we’ve learned in health care is the most effective way to help facilitate behavior change for people who are interested. And the whole point is basically an acknowledgement that people are in charge of their own lives, their own healthcare decisions, and their own children’s health care decisions. And as much as I as a provider might want all of my patients to get the vaccine, that’s not my decision to make. And if I just tell people, ‘no, this is what you need to do,’ that’s not going to help them feel more comfortable with the decision. It’s not going to encourage them to make a decision. It’s only going to alienate them from health care and be more likely to drive them to less reputable sources of information. So it’s important to recognize and respect people’s autonomy, and that’s what I try to do. If they want to have a conversation, I encourage that and I’m happy to have that. If they’re not ready for it, then I respect that decision, or at least I try to respect that decision.

Miller: But that thinking could lead someone to say that a mandate for whooping cough vaccines, and varicella, and MMR, and on and on, the things that some people have pushed back against for decades, but the vast majority have not. You could argue that none of those are the right approach. How do you feel about the possibility of a vaccine mandate for school age kids for COVID-19?

Hassan: That’s a really good question. I would make a distinction between my job as a physician and the role of the government has in passing laws and policies to preserve the public health [and] serve the public interest. So as a physician, my job is to counsel patients and provide answers to their questions [and] help them navigate their own healthcare decisions. I don’t make decisions for people and I don’t punish people for wrongdoings or enforce policies or laws for people. But the government’s job is very different. Their job is hopefully to educate. But also they have to make laws to make sure they’re keeping us healthy. And so we have requirements for school age vaccines already because we know that, even though that is to some extent an infringement on people’s right to send their kids to school without getting them a vaccine they didn’t want, that is outweighed by other families’ rights to not have their kids exposed needlessly to potential preventable diseases while getting their public education. I think that same line of reasoning applies when we’re talking about a COVID vaccine mandate.

It’s not as though it’s an easy decision to make. It’s not fair for parents to have to choose between sending their kid to school and getting them healthcare decisions they don’t agree with. But it’s also not fair for parents to have to be forced to choose between sending their kid to school and exposing them to preventable diseases.

Miller: Patrick Allen, before we say goodbye, I just wanted to note some of the huge geographical differences here. The spread from county to county in vaccination rates among Oregon youth is gigantic. This is among 12 to 17 year olds. In Multnomah County, for example, 78% of that age group have had at least one dose. 17%. In Lake County. It’s a much higher gulf than if you look at the populations as a whole from county to county, meaning only about one out of six adolescents in Lake County has gotten at least one dose, and it seems reasonable that we could assume similar numbers for this younger age group. What can or should happen at the state level in response to that?

Allen: I think that the challenge is to try to provide good information so that people can make as informed a choice as they possibly can. I think there’s a lot of talk that is accurate that kids are at less risk than seniors from COVID, but I think a lot of people hear that and translate that as kids are at no risk from COVID. And that simply isn’t true. There’s multi inflammatory syndrome that occurs in kids. There’s long COVID that causes effects for over a drawn out period of time. Surprisingly COVID, over the last several months, has been one of the top 10 causes of death for children under age 15 in the United States. Helping people understand that their kids do have risks from COVID, and that they are also able to spread it to people who are more vulnerable, is really important [and] is going to be key to helping to try to get those vaccination rates up.

Miller: Patrick Allen and Ryan Hassan, Thanks for your time today. I appreciate it.

Allen / Hassan: You’re welcome. Thanks so much.

Miller: Patrick Allen is the director of the Oregon Health Authority. Ryan Hassan is a pediatrician in Happy Valley who is on the Medical Board of Boost Oregon.  It’s a parent group that provides evidence-based information about vaccines.

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